Comprehensive Outcomes Analysis of 34 Patients: Neoadjuvant Chemotherapy for Sinonasal Teratocarcinosarcoma

Introduction/Background: Sinonasal teratocarcinosarcoma (SNTCS) is one of the rarest neurological conditions in the world, with an incidence rate of less than 3% for all head and neck cancers and less than 1% of all tumors. SNTCS is a topic discussed less within the medical databases, yielding only in the low hundreds. Neoadjuvant chemotherapy (NACT) before surgery in SNTCS is explored even less due to its current rarity. The objective of this study is to evaluate the outcomes of neoadjuvant chemotherapy in SNTCS.

Methods: This systematic review was conducted according to the PRISMA guidelines as shown by the flowchart below. Three notable databases were utilized: PubMed, Embase, and Web of Science. All preliminary steps such as full-text screening of the systematic review were conducted through Rayyan.AI. Quality assessment was done with the Joanna-Briggs critical appraisal research tool. Statistical analysis was conducted through Microsoft Excel and R 04.21.02 (RStudio). The graphs, figures, and tables were made through MATLAB version R2024a (Mathworks).

Results: Five studies fully matched the inclusion criteria of this study yielding a total of 34 patients by case reports and retrospective studies ([Fig. 1]). Outcomes, tumor location, and treatment summary were assessed meticulously. In a retrospective analysis with 23 males and 4 females (median age: 42 years) who underwent NACT, results indicated 53.2% had a 2-year progression-free survival. Additionally, overall survival after 2 years was seen in 60.9% of patients. Unfortunately, risks in chemotherapy toxicity were present due to a subject casualty. A separate study involved three patients with ethmoid sinus tumors. One patient showed partial tumor response through NACT but developed leptomeningeal metastases shortly after surgery. The patient died 3 months after diagnosis. Patients 2 and 3, through comparable adjuvant therapy, had a longer survival period posttreatment, but they also eventually developed metastases, dying 32 and 6 months respectively after diagnosis. Another case report involved 2 patients, both with left nasal cavity tumors, who underwent NACT (2–3 cycles of cisplatin and etoposide every 21 days) with R0 follow-up resection, becoming asymptomatic 2 to 3 months after follow-up chemoradiotherapy. A study with one patient involved a tumor in the left nasal cavity, received three cycles of NACT followed by surgery, but results were inconclusive. An older study (2009) found bone-destroying lesions of the paranasal sinuses and nasal cavity; after being administered by four cycles of NACT with Cisplatin and Adriamycin (with a follow-up of surgery), the patient was asymptomatic after 10 months.

Fig. 1

Conclusion: The majority of results in this study were based on small case series or single/double case studies. Therefore, extensive studies should be conducted to prove NACT as an impactful option in SNTCS. However, neoadjuvant therapy does appear as a promising addition to current therapy in sinonasal teratocarcinosarcoma by correlation only. A plausible solution to this would be to develop a registry of SNTCS and the types of therapies to characterize its outcomes significantly better.

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Artikel online veröffentlicht:
07. Februar 2025